Scott Barkowski, Ph.D.

Assistant Professor

John E. Walker Department of Economics

Clemson University

Email: sbarkow {at} clemson {dot} edu

Curriculum Vitae

Fields of research interest

  • Health economics

  • Labor economics

  • Applied Econometrics

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Working Papers

Physician Response to Prices of Other Physicians: Evidence from a Field Experiment (Under Review)

ABSTRACT: Recent efforts to increase price transparency for American consumers of health care have largely failed to produce savings. Medical-field research on physician-side price transparency, however, has shown promise for savings but suffers from pervasive methodological problems. I perform a field experiment that addresses these measurement difficulties while studying an area that has received little attention: physician referrals. Working with a group of medical practices linked as an Independent Practice Association (IPA), I randomly selected primary care practices to receive a list of average costs -- that is, prices -- for new referrals to six ophthalmology practices that were part of the IPA's provider network. These practices handled the bulk of the IPA's ophthalmology patients and represented substitute providers. Using the IPA's administrative data on referrals, I find that during the first two months following the distribution of the price list, the treatment group primary care physicians (PCPs) increased referral share towards the least expensive ophthalmology practice by 147 percent. These referrals were allocated away from the most expensive practice and those not listed on the report. These effects were only found, however, for patients for whom the PCPs had a cost reduction incentive. The large initial effect dissipated over the following four months. For patients with a limited financial interest for the PCPs, I find little evidence of a treatment response. These contrasting results suggest the PCPs were influenced by cost reduction motives and provide more evidence of the potential for savings from physician-side price transparency.

Interpretation of Nonlinear Difference-in-differences: The Role of the Parallel Trends Assumption (Under Review)

ABSTRACT: I argue interpretation of nonlinear difference-in-differences models depends on the form of the parallel trends assumption. When they are assumed in the natural scale of the dependent variable, the treatment effect is the interaction effect (a cross-difference). If they are assumed in the transformed scale, it is a single difference. I further note that assuming parallel trends in one scale implies they do not hold in the other, except in special cases. Finally, I consider log-linear (and related) difference-in-differences models and provide a constant form of the treatment effect that is comparable across applications with different parallel trends assumptions.

Young Children and Parents' Labor Supply during COVID-19 (Under Review)

ABSTRACT: We study the COVID-19 pandemic’s effects on the labor supply of parents with young children. Using the monthly Current Population Survey (CPS), and following a pre-specified analysis plan, we use three variations of difference-in-differences to compare workers with childcare needs to those without. The first compares parents with young children and those without young children, while the second and third rely on the presence of someone who could provide childcare in the household: a teenager in one and a grandparent in the other. We analyze three outcomes: whether parents were “at work” (not sick, on vacation, or otherwise away from his or her job); whether they were employed; and hours worked. Contrary to expectation, we find the labor supply of parents with young children was not negatively affected by the COVID-19 pandemic. Instead, some evidence suggests they were more likely to be working after the pandemic unfolded. For the outcomes of being at work and employed, our results are not systematically different for men and women, but some findings suggest women with young children worked almost an hour longer per week than those without. We provide evidence from questions newly added to the CPS during the pandemic that parents were more likely to work remotely than non-parents, suggesting employer flexibility with regard to telework aided parents in avoiding negative shocks to their labor supply. These new questions also provide evidence against the possibility that a positive labor demand shift (relative to non-parents) could be driving our results.

Work in Progress

Effects of Local-government Facemask Mandates on COVID-19 Cases

  • With Krishna Khatri

Medicaid Expansion Spillovers to Health Care Consumption and Coverage

OK Boomer? Burden of Proof Law and Age Discrimination

Educational Impacts of Making College Tuition Free

Published / Forthcoming Articles

In Sickness and in Health: Interaction Effects of State and Federal Health Insurance Coverage Mandates on Marriage of Young Adults

ABSTRACT: We study the interaction of state and federal dependent health insurance mandates on young adult marriages. Using a new dataset on state-level mandates, we show marriage restrictions of these laws reduced marriage likelihoods by about two percentage points. When the Affordable Care Act (ACA) was enacted, its mandate ended marriage restrictions, encouraging marriage among those previously eligible for state mandates. However, among those ineligible for state mandates, it discouraged marrying to obtain insurance through spouses. The combination of these contrasting ACA effects eliminated the marriage gap. We also find these marriage effects resulted in corresponding impacts on out-of-wedlock births.

A Reevaluation of the Effects of State and ACA Dependent Coverage Mandates on Health Insurance Coverage

ABSTRACT: We study state and federal health insurance coverage mandates for young adults. Despite consistent findings that the Affordable Care Act's (ACA) federal mandate was effective, research has disagreed on whether pre-existing, state-level mandates were successful in increasing coverage. We reconsider the issue with a new analytical perspective and newly available, accurate data on state mandates. We show that the impact of the state mandates was substantive and concentrated among young adults between ages 19 and 23. Our estimates indicate that the dependent coverage rose by 3.9 percentage points and overall coverage rose by 3.3 percentage points. Crowd out of coverage through young adults' own jobs was negligible. For those above 23, we find little evidence of changes in coverage. We incorporate these insights into analysis of the ACA's mandate, showing its effects were focused among those who were not eligible for state mandates, or were eligible but older than 23. Our results suggest eligibility restrictions played important roles in limiting the scope of the state mandates, but they can be practical and effective tools for policymakers looking to ensure or expand coverage for young adults in the face of uncertainty about the ACA.

Does Government Health Insurance Reduce Job Lock and Job Push?

ABSTRACT: I study job lock and job push, twin phenomena believed to be partially due to employment-contingent health insurance (ECHI). Using variation in Medicaid eligibility among household members of male workers to identify changes in those workers’ reliance on ECHI, I estimate notable job lock and job push effects. For married male workers, a 15 percentage point increase in the likelihood a household member is eligible for Medicaid increases the rate of voluntary job exits over a four-month period by 14 percent. For job push, the same increase in a household member’s likelihood of Medicaid eligibility reduces the transition rate into jobs with ECHI among all male workers by 8 percent.

The Effect of Health Insurance on Crime: Evidence from the Affordable Care Act Medicaid Expansion

ABSTRACT: Little evidence exists on the effect of the Affordable Care Act (ACA) on criminal behavior, a gap in the literature that this paper seeks to address. Using a simple model, we argue we should anticipate a decrease in time devoted to criminal activities in response to the expansion, since the availability of the ACA Medicaid coverage raises the opportunity cost of crime. This prediction is particularly relevant for the ACA expansion since it primarily affects childless adults, a population likely to contain individuals who engage in criminal behavior. We validate this forecast empirically using a difference-in-differences framework, estimating the expansion's effects on panel datasets of state- and county-level crime rates. Our estimates suggest that the ACA Medicaid expansion was negatively associated with burglary, vehicle theft, homicide, robbery, and assault. These crime-reduction spillover effects represent an important offset to the government's cost burden for the ACA Medicaid expansion.

Does Regulation of Physicians Reduce Health Care Spending?

ABSTRACT: The medical community argues that physician fear of legal liability increases health care spending. Theoretically, though, the effect could be positive or negative, and empirical evidence has supported both cases. Previous studies, however, have ignored the fact that physicians face risk from industry oversight groups like state-level medical licensing boards in addition to civil litigation risk. This paper addresses this omission by incorporating previously unused data on punishments by oversight groups against physicians, known as adverse actions, along with malpractice payments data to study state-level health care spending. My analysis suggests that, contrary to conventional wisdom, spending does not rise in response to increased risk. An increase in adverse actions of 16 (the year-to-year average) is associated with statistically significant, annual decreases in state spending on hospital care of approximately $22 million, and on prescription drugs of nearly $10 million. Malpractice payments are estimated to have smaller, statistically insignificant effects.

Does Employer-provided Health Insurance Constrain Labor Supply Adjustments to Health Shocks? New Evidence on Women Diagnosed with Breast Cancer

ABSTRACT: Employment-contingent health insurance may create incentives for ill workers to remain employed at a sufficient level (usually full-time) to maintain access to health insurance coverage. We study employed married women, comparing the labor supply responses to new breast cancer diagnoses of women dependent on their own employment for health insurance with the responses of women who are less dependent on their own employment for health insurance, because of actual or potential access to health insurance through their spouse’s employer. We find evidence that women who depend on their own job for health insurance reduce their labor supply by less after a diagnosis of breast cancer. In the estimates that best control for unobservables associated with health insurance status, the hours reduction for women who continue to work is 8 to 11 percent smaller. Women’s subjective responses to questions about working more to maintain health insurance are consistent with the conclusions from observed behavior.

Just For Fun

Economics Conference Bingo

ABSTRACT: We describe a bingo-style game intended to be played at economics conferences. Early results from implementation of the game by economists at conferences suggest that fun increases more than a full standard deviation. Further study of the effects of the game is ongoing.